Niamh M. Higgins

Psychotic experiences in the population: association with functioning and mental distress

Psychotic experiences are far more common in the population than psychotic disorder. They are associated with a number of adverse outcomes but there has been little research on associations with functioning and distress. We wished to investigate functioning and distress in a community sample of adolescents with psychotic experiences. Two hundred and twelve school-going adolescents were assessed for psychotic experiences, mental distress associated with these experiences, global (social/occupational) functioning on the Childrens Global Assessment Scale, and a number of candidate mediator variables, including psychopathology, suicidality, trauma (physical and sexual abuse and exposure to domestic violence) and neurocognitive functioning. Seventy five percent of participants who reported psychotic experiences reported that they found these experiences distressing (mean score for severity of distress was 6.9 out of maximum 10). Participants who reported psychotic experiences had poorer functioning than participants who did not report psychotic experiences (respective means: 68.6, 81.9; OR=0.25, 95% CI=0.14-0.44). Similarly, participants with an Axis-1 psychiatric disorder who reported psychotic experiences had poorer functioning than participants with a disorder who did not report psychotic experiences (respective means: 61.8, 74.5; OR=0.28, 95% CI=0.12-0.63). Candidate mediator variables explained some but not all of the relationship between psychotic experiences and functioning (OR=0.48, 95% CI=0.22-1.05, P<0.07). Young people with psychotic experiences have poorer global functioning than those who do not, even when compared with other young people with psychopathology (but who do not report psychotic experiences). A disclosure of psychotic experiences should alert treating clinicians that the individual may have significantly more functional disability than suggested by the psychopathological diagnosis alone.

Individual differences in adaptation of cardiovascular responses to stress

Previous research has described patterns of adaptation of cardiovascular responses across prolonged or recurring stress. However, despite important implications for the study of reactivity, relatively little research has directly examined the antecedents or consequences of this adaptation. We present data showing that neuroticism, a personality trait associated with dispositional appraisals of stress, is associated with reductions in HR, CO, and TPR responses across stress exposures. Comparisons of reactivity curves suggest blunted initial stress responses among persons with high neuroticism, and higher initial responses followed by greater decreases among persons with low neuroticism. The data also suggest an association between adaptation of cardiovascular responses and myocardial hemodynamic responding. Such findings shed new light on previous studies detecting healthful correlates of short-term stress responding, and highlight the relevance of adaptation to future cardiovascular reactivity research.

Habituation-sensitization of cardiovascular reactivity to repeated stress in smokers and non-smokers: An anthropometrically matched trial

Previous research has been equivocal as to the impact of smoking status on cardiovascular reactivity to challenge. In addition, little is known about patterns of cardiovascular response habituation-sensitization to repeated challenge, in either smokers or the general population as a whole. The present study sought to clarify whether smokers and non-smokers differ in cardiovascular reactivity to challenge, or in patterns of reactivity to repeated challenge. 28 smokers and 28 anthropometrically matched non-smokers underwent repeated cardiovascular reactivity assessment. Results suggest that smokers had higher diastolic blood pressure (DBP) than non-smokers, and that female non-smokers demonstrated DBP response sensitization. Findings highlight direct associations between smoking and cardiovascular reactivity of potential significance to the etiology of cardiovascular disease.

Individual differences in the impact of attentional bias training on cardiovascular responses to stress in women.

Abstract Experimental studies show that training people to attend to negative stimuli makes them more likely to respond with greater anxiety to stress. The present study investigated this effect in students using measures of cardiovascular responses to stress and examined whether individual differences influence the impact of attention training on stress responses. Using a standard dot probe task, 30 participants underwent negative attentional bias training and 34 participants underwent anti-negative training before completing a stressful speech task. Results indicated that, overall, participants exhibited acclimatization to the procedures (indicated by a dip in blood pressure post-training) and normal stress responding (indicated by elevated blood pressure in response to stress; p<.001). However, consideration of participants’ scores for neuroticism/emotional-stability revealed important differences in how the intervention impacted on cardiovascular profiles (p=.008). For participants with high neuroticism scores, the negative attentional bias intervention elicited more exaggerated stress responding than the anti-negative intervention. For those with low neuroticism scores (i.e., emotionally stable participants), the anti-negative intervention was associated with elevated post-intervention blood pressure and higher blood pressure reactivity to stress. These findings provide evidence of the impact of attentional bias manipulation on physiological stress reactivity and suggest the effect is highly contingent on individual temperaments.

Early interventions to promote work participation in people with regional musculoskeletal pain: a systematic review and meta-analysis

Objectives: To determine the effectiveness of early multidisciplinary interventions in promoting work participation and reducing work absence in adults with regional musculoskeletal pain. Data sources: Seven databases (CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, OT Seeker, PEDro; 1990 to December 2016) were searched for eligible studies. Review methods: Trials were included if they reported on work-based outcomes for participants experiencing difficulties at work or ≤ three months’ sick leave. Interventions had to include two or more elements of the biopsychosocial model delivered as a coordinated programme. Quality was assessed using the GRADE criteria. Results were analysed by hazard ratios for return to work data; continuous outcomes were analysed as standardised mean difference with 95% confidence intervals. Results: A total of 20 randomized controlled trials, with 16,319 participants were included; the interventions were grouped according to their main components for meta-analyses. At 12-months follow-up, moderate quality evidence suggests that programmes involving a stepped care approach (four studies) were more effective than the comparisons in promoting return to work (hazard ratio (HR) 1.29 (95% confidence interval (CI) 1.03 to 1.61), p = 0.03), whereas case management (two studies) was not (HR 0.92 (95% CI 0.69 to 1.24), p = 0.59). Analyses suggested limited effectiveness in reducing sickness absences, in pain reduction or functional improvement across the intervention categories. Conclusion: There is uncertainty as to the effectiveness of early multicomponent interventions owing to the clinical heterogeneity and varying health and social insurance systems across the trials.

Functional Connectivity Anomalies in Adolescents with Psychotic Symptoms.

Background Previous magnetic resonance imaging (MRI) research suggests that, prior to the onset of psychosis, high risk youths already exhibit brain abnormalities similar to those present in patients with schizophrenia. Objectives The goal of the present study was to describe the functional organization of endogenous activation in young adolescents who report auditory verbal hallucinations (AVH) in view of the “distributed network” hypothesis of psychosis. We recruited 20 young people aged 13–16 years who reported AVHs and 20 healthy controls matched for age, gender and handedness from local schools. Methods Each participant underwent a semi-structured clinical interview and a resting state (RS) neuroimaging protocol. We explored functional connectivity (FC) involving three different networks: 1) default mode network (DMN) 2) salience network (SN) and 3) central executive network (CEN). In line with previous findings on the role of the auditory cortex in AVHs as reported by young adolescents, we also investigated FC anomalies involving both the primary and secondary auditory cortices (A1 and A2, respectively). Further, we explored between-group inter-hemispheric FC differences (laterality) for both A1 and A2. Compared to the healthy control group, the AVH group exhibited FC differences in all three networks investigated. Moreover, FC anomalies were found in a neural network including both A1 and A2. The laterality analysis revealed no between-group, inter-hemispheric differences. Conclusions The present study suggests that young adolescents with subclinical psychotic symptoms exhibit functional connectivity anomalies directly and indirectly involving the DMN, SN, CEN and also a neural network including both primary and secondary auditory cortical regions.

THU0550 Early Multidisciplinary Interventions To Promote Work Participation in People with Regional Musculoskeletal Pain: A Systematic Review

Background Musculoskeletal disorders are amongst the leading causes of disability in the working age population. Whilst there is a growing body of evidence suggesting that early targeted multidisciplinary interventions can promote work retention and prevent disability, the evidence is far from conclusive as to which interventions are the most effective. Objectives To review randomised controlled trials evaluating the effectiveness of early interventions in promoting work participation in adults with regional musculoskeletal pain (RMSKP). Methods CENTRAL, MEDLINE, EMBASE, Scopus, PEDro and OT Seeker (1990 to April 2015) were searched. Reference lists of identified articles and reviews were hand searched. Only RCTs reporting on work-related outcomes were eligible for inclusion. The intervention had to include two or more elements of the biopsychosocial model delivered as an integrated programme. Participants were either experiencing difficulties at work or had less than three months sick leave as a result of their RMSKP at enrolment. Each RCT was assessed independently by two reviewers for risk of bias. Results were analysed by hazard ratios for return to work data, while continuous outcomes were analysed as mean difference (MD) with 95% confidence intervals. Results 19 RCTS were included; the considerable variation in the components employed in the interventions limited the option to pool the data statistically using meta-analysis. There was some evidence that programmes involving a stepped care approach (4 studies) increased the probability of return to work at the 12-month follow-up [HR 1.29 (95% CI, 1.03 to 1.61), p=0.03]. However, preliminary analyses indicate a lack of consistent evidence for effects on reducing sickness absences, pain reduction and functional improvement across the intervention types. Conclusions The lack of agreement as to what constitutes “early” in the context of treating RMSKP may have contributed to the rather ambiguous findings. In addition, the different health and social insurance systems across the trials have made it difficult to generalise the results. There remains a need to establish the active components that promote work retention in this population, and to identify the patients who are most likely to benefit from an integrated and cost-effective intervention. Disclosure of Interest None declared

THU0625 Healthcare Professionals' Perspectives on The Design and Implementation of An Early Integrated Care Intervention for Musculoskeletal Pain in The Irish Healthcare Setting: A Qualitative Study

Background Musculoskeletal disorders are amongst the leading causes of disability in the working age population. Growing evidence suggests early screening and targeted interventions during the acute phase can promote work retention and prevent disability. Objectives This study aims to develop and feasibility test an early, case manager-led intervention focusing on work as a clinical outcome. Here we report qualitative findings from focus groups and interviews conducted to consider issues of content, delivery and optimal timing, and to explore key priorities and potential challenges in service delivery. Methods Two focus groups and three individual interviews were conducted, involving 17 experts representing the multidisciplinary team. Thematic analysis was used to summarise the views and ideas expressed. Results Participants highlighted the importance of early access to diagnosis, relevant investigations and referral to specialists as necessary in reducing the risk of long term disability; noting the critical importance of GPs in facilitating early access. The need to provide reassurance and education about the patients condition was highlighted, as was the importance of screening for psychosocial risk factors. Patients most likely to benefit from the intervention were identified as those highly motivated to maintain their current work roles. Ready access to the MDT and the skill set of the case manager were noted as critical concerns, resource constraints pose considerable challenges. Conclusions Introduction of an early integrated care intervention that targets risk of work disability is warranted. Considerable “buy-in” is required from all stakeholders involved. The data will help to inform the planned feasibility study. Acknowledgement We would like to thank all of the individuals who participated in the interviews and focus groups. Disclosure of Interest None declared

Poster #M69 WHAT LIES BENEATH? A THEMATIC CONTENT ANALYSIS OF SUB-CLINICAL PSYCHOTIC EXPERIENCES AMONG CHILDREN AND YOUNG ADOLESCENTS FROM THE GENERAL POPULATION IN IRELAND AND THE UK

The idea that the content of delusions and hallucinations may have meaning or be symbolically significant is not new. From a psychodynamic perspective, the experience of psychosis has long been conceptualised as a defence against unbearable or unmanageable emotions (Martindaleetal2013)andthecontentofpsychoticexperiencesistherefore considered to have meaning and relevance for clinical practice (Martindale 2007). In adult samples, the content of delusions and hallucinations has been found to be associated with the experience of trauma and abuse (Raune et al. 2006, Reiff et al. 2012). To the best of our knowledge, no study to date has examined the content of sub-clinical psychotic-like experiences (PLEs) using non-clinical child or adolescent samples. This study aims to identify the presence of themes in the content of PLEs among children and adolescents from the general population and to examine associations between the content of the psychotic experience and adverse or abusive life events.

Handbook of adult resilience, edited by John W. Reich, Alex J. Zautra, and John Stuart Hall

In a contemporary world fraught with economic and socio-political turmoil as well as great uncertainty about the role (or capacity) of the state to look after the needs of its citizens, there is increasing interest in the attributes that enable people to survive the rigors not only of traumatic, catastrophic, and stressful life experiences, but also of daily life as it is normally lived. Developmental psychologists have traditionally (although perhaps unconsciously) examined resilience factors when studying the adaptations required by transitions from childhood to adolescence and from adolescence to adulthood; similarly, clinical and health psychologists have created a resilience-shaped niche out of person and social factors that assist with stresscoping in ways that boost well-being. However, as noted by the Resilience Solutions Group (RSG) at Arizona State University, psychology as a whole has been slow to draw these disparate strands together in order to shape a unified understanding of resilience as it manifests itself in the typically developing adult. The present volume, edited by three of the RSG’s most distinguished members, represents a noble effort in synthesizing these concepts, providing readers with a thorough, thoughtful, and varied treatise of psychological resilience in adulthood. As with any attempt to corral a disparate literature within a putatively new paradigm (or, to use the editors’ own analogy, when attempting to progress the science of resilience toward a Kuhnian revolution), one conspicuous challenge to contributors is to achieve an agreed vocabulary. Significantly, there exists no one consensually agreed definition of the notion of resilience. Previous attempts to address the concept have variably conceived of it as a stable disposition (perhaps heritable at a genetic level), a systemic process (inherently contingent on the interaction between environment and personal actions), or a commodified resource (amenable to transmission across individuals in the form of ‘resilience-building’ skills interventions). Nonetheless, whatever approach is taken, most scholarly treatments of resilience encapsulate either the ability to recover quickly from stressful experiences, or the ability to accumulate a continuing enhancement of personal function over time as ordinary life is encountered (with or without the occurrence of stress), or both. Such nuances echo those faced by social support theorists some 20 years ago, when speculating as to whether social interactions exert stress-buffering or direct effects on recipient well-being. It is not yet clear whether the present editors’ Kuhnian revolution has succeeded, however, as the accumulated contributions to this volume appear to retain a substantial degree of inter-disciplinary balkanization: how resilience is defined for research purposes largely continues to depend on the disciplinary position of those conducting the research. It is also unclear whether considerations of the dispositional nature of resilience are fully reconciled with extant psychological theory. Laudably, the volume includes perspectives that run the gamut of the behavioral sciences, including biological, cognitive, behavioral, and social psychology, as well as applied subdisciplines spanning organizational, cultural, and health contexts. Such heterogeneity is very much a strength of the present volume. Notably, for a topic that lends itself to psychologization, the chapters on its biological substrates are particularly strong. The chapter of Feder, Nestler, Westphal, and Charney presents a physiological background to resilience functionality, while the chapter by Lemery-Chalfant outlines its genetic aspects. These authors are to be commended in retaining the specificity of neural and genetic vocabulary while presenting the material in a manner that is comprehensible to a more general scholarly readership (however, it is a little surprising that the implications of resilience for physical health are not covered in more detail, as might be derived from the extensive literature in psychoneuroimmunology that links coping to beneficial health outcomes). In a novel way, the quasi-biological theme of adaptive ecosystems is continued in the chapter by Denhardt and Denhardt, which ostensibly examines the nature of resilience in organizations. While noting that what is positive for an organization might not be positive for the individual actors within it, these authors attempt to outline ways of building resilience in workforce members in ways that contribute to group-level efficiency. With considerable insight, they conclude that organizational